Publicaciones 2012

Tamara Illescas, Dolores Ortega, Patricia Soler, Gloria Costa, Pluvio Coronado and Joaquín Montalvo. First trimester screening for aneuploidies in successive pregnancies: correlations between markers. Prenatal Diagnosis 2012, 32, 50–56 .


Objectives: Screening for chromosomal abnormalities in the first trimester of pregnancy is based on maternal age, nuchal translucency (NT), and biochemical markers (pregnancy-associated plasma protein-A and free beta human chorionic gonadotrophin). We have assessed the influence of screenings and outcomes in previous pregnancies on screenings in subsequent pregnancies.

Methods: Retrospective study of the correlation between the variables of first trimester combined screening for chromosome abnormalities in patients with subsequent pregnancies. Excluded were gestations with fetal aneuploidies.

Results: Between July 1999 and December 2009, there were 2291 women with more than 1 euploid pregnancy screened in the first trimester in our hospital. Therewas amoderate correlation for pregnancy-associated plasma protein-A (ρ = 0.530, p <0.001) and free beta human chorionic gonadotrophin (ρ = 0.439, p <0.001) between the first and second pregnancy. The trend continued in successive pregnancies. NT showed no correlations of clinical importance. With an overall false positive (FP) rate of 2.1% for the combined screening, the probability of having a recurrent FP in the second pregnancy was 4.3% (not significant).

Conclusion: There are significant correlations between biochemical markers but not NT in successive pregnancies, leading to increased risk of recurrence of FP results. However, such increase is not statistically significant if the overall FP rate is very low.

Waldo Sepulveda, MD, Daniel Cafici, MD, Julie Bartholomew, DMU, Amy E. Wong, MD, Pilar Martinez-Ten, MD. First-Trimester Assessment of the Fetal Palate A Novel Application of the Volume NT Algorithm. J Ultrasound Med 2012; 31:1443–1448.


We describe a new technique that can facilitate the first-trimester examination of the fetal palate using the Volume NT algorithm (Samsung Medison, Seoul, Korea), a program that automatically detects the exact midsagittal plane of the head and is primarily designed for semiautomatic measurement of the nuchal translucency thickness. Three-dimensional (3D) data sets from the fetal face were captured with Volume NT and subsequently reformatted with the Oblique View software to obtain orthogonal views of the primary and secondary palate in coronal and axial planes, respectively. By testing this method in selected 3D data sets obtained retrospectively (n = 12) and prospectively (n = 28), we were able to extract clinically acceptable views of the fetal palate in all cases. This preliminary report shows that with this new 3D automation development, early evaluation of the fetal palate is feasible and reproducible and could be easily incorporated into the first-trimester sonographic protocol once its ability to detect abnormal cases is demonstrated.

Tamara Illescas, Pilar Martínez-Ten, Mónica Rodríguez, César Abelleira, Begoña Adiego y Eugenia Antolín. ¿Cuál es tu diagnóstico?. Drenaje venoso pulmonar anómalo total infradiafragmático obstructivo Diagn Prenat. 2012. doi:10.1016.

Manuel Recio Rodríguez , Pilar Martínez Ten, Javier Pérez Pedregosa, Carmina Bermejo López, Inés Tamarit Degenhardt, Ignacio Pastor Abascal. RM fetal: patología torácica y abdómino-pélvica. RAR - Volumen 76 - Número 1 – 2012.


Resumen: Aunque la ecografía (US) es el método de elección en la evaluación del feto, la resonancia magnética (RM) es una técnica complementaria a la US en el diagnóstico de las anomalías fetales. Entre las ventajas de la RM se destacan un excelente contraste tisular, un campo de visión grande y una relativa operador-independencia. La mayoría de los trabajos previos de RM fetal han estudiado el sistema nervioso central (SNC). Sin embargo, la RM es útil en la evaluación de las anomalías torácicas y abdominales. En este artículo se muestran los diferentes aspectos por RM de las anomalías fetales torácicas y abdominales y se discuten las indicaciones y ventajas de la RM fetal.

Waldo Sepulveda, Amy E. Wong, MD, Francisco Sepulveda, Pilar Martinez-Ten, MD, Renato Ximenes, MD. Fetal magnetic resonance imaging and three-dimensional ultrasound in clinical practice: General aspects. Best Practice & Research Clinical Obstetrics and Gynaecology 26 (2012) 575–591.


Ultrasonography is used routinely during pregnancy to screen and diagnose fetal anomalies. Two-dimensional ultrasound is usually adequate in women at low risk for malformations. When technical factors limit optimal evaluation or a malformation is suspected, further imaging with three-dimensional ultrasound and magnetic resonance imaging is becoming increasingly common. Threedimensional ultrasound allows the manipulation of data acquired from two-dimensional ultrasound to recreate an infinite number of views, thereby enhancing the ability to evaluate the fetal anatomy. When three-dimensional ultrasound is either unavailable or inadequate, fetal magnetic resonance imaging permits detailed evaluation of the suspected anomaly and assesses the presence of associated anomalies. In this chapter, we review the techniques, advantages, limitations, and clinical applications of these two fetal imaging modalities.

Waldo Sepulveda, MD, Renato Ximenes, MD, Amy E. Wong, MD, Francisco Sepulveda, MD, , Pilar Martinez-Ten, MD.. Fetal magnetic resonance imaging and three-dimensional ultrasound in clinical practice: Applications in prenatal diagnosis. Best Practice & Research Clinical Obstetrics and Gynaecology 26 (2012) 593–624.


Three-dimensional ultrasound and magnetic resonance imaging are powerful imaging techniques that are used increasingly in evaluating fetal anatomy. In this chapter, we review the main applications of these imaging modalities in current practice and present an overview of the malformations that may benefit from assessment with three-dimensional ultrasound and magnetic resonance imaging.

Begoña Adiego, Tamara Illescas, Pilar Martinez-Ten, Carmina Bermejo, Javier Perez-Pedregosa, Amy E. Wong and Waldo Sepulveda. Intracranial translucency at 11–13 weeks of gestation: prospectiveevaluation and reproducibility of measurements. Prenatal Diagnosis 2012, 32, 259–263.


Objective: This paper aimed to determine the feasibility of identifcation and measurement reproducibility of intracranial translucency (IT) in our population.

Methods: This is a prospective study in which fve accredited operators attempted to identify and measure the IT during frst-trimester sonographic screening for aneuploidy in 990 fetuses. The presence or absence of spina bida was determined at the time of the second-trimester scan or after birth. Measurement reproducibility was assessed through intraclass correlation coef!cient (ICC) on a subgroup of 150 fetuses.

Results: Identifcation and measurement of the IT were possible in 961 (97%) cases. The mean IT anteroposterior diameter was 1.8mm (SD ±0.37; range 0.8–3.1), and the size increased linearly with advancing gestation (IT = 0.74 + 0.02 x crown–rump length; r2 = 0.15, p<0.0001). The only fetus with spina bifda in this series presented with absent IT. Intra-observer and inter-observer ICCs were 0.79 and 0.75, respectively (95% confdence intervals 0.72–0.84 and 0.67–0.81, respectively; both p<0.001).

Conclusions: The IT increases linearly with increasing crown–rump length and seems to be of value in the frsttrimester detection of spina bifda. It is easy to identify and measure and shows excellent intra-observer and interobserver reproducibility measurements.

P. Martinez-Ten, B. Adiego, T. Illescas, C. Bermejo, A. E. Wong and W. Sepulveda. First-trimester diagnosis of cleft lip and palate using three-dimensional ultrasonography. Ultrasound Obstet Gynecol 2012; 40: 40–46.


Objective: To determine whether systematic examination of primary and secondary palates using three-dimensional (3D) ultrasound aids in the identification of orofacial clefts in the first trimester.

Methods: 3D datasets were acquired prospectively from women undergoing first-trimester ultrasound screening for aneuploidy. Multiplanar mode display was used for offline analysis of (1) the primary palate in the coronal plane at the base of the retronasal triangle and (2) the secondary palate by virtual navigation in the axial plane. In addition, 3D datasets from three fetuses with a cleft palate diagnosed in the first trimester were retrospectively identified and included randomly in the study group.

Results: A total of 240 3D datasets from 237 pregnancies (including three sets of twins), 89% of which were obtained transabdominally and 11% transvaginally, wereexamined independently by three operators. The quality of the 3D datasets was classified subjectively as good, fair and poor in 76%, 20% and 4% of cases, respectively. Seven fetuses had an orofacial cleft; all involved both the primary palate and the secondary palate. Using 3D offline analysis, the primary palate was classified as intact in 229 (95%), cleft in nine (4%) and indeterminate in two (1%). Seven of the nine fetuses suspected to have acleft affecting the primary palate had the cleft confirmed at birth or at postmortem examination (false-positive rate 0.9% (2/231)). The secondary palate was classified as intact in 217 (90%), cleft in six (3%) and indeterminate in 17 (7%). Clefts of the secondary palate were confirmed in all six suspected cases and missed in one, which was diagnosed at 16 weeks. The visualization rate was affected by the quality of the 3D dataset (P<0.001) and gestational age at evaluation (P<0.01).

Conclusion In our series, all cases of clefting of the primary palate and 86% of cases involving the secondary palate were visualized using 3D ultrasound with a satisfactory false-positive rate. Virtual navigation of the fetal palate using the multiplanar mode display seems to be useful in the diagnosis of clefting in the first trimester.

Adiego Burgos MB, Martínez-Ten P, Illescas Molina T. Desarrollo embrionario del encéfalo fetal: evaluación ecográfica. (2012). En: Martínez Cortés L y Huertas Fernández MA Editors. Neurosonografía fetal Normal (pp 13-30). Barcelona, España. Editorial Glosa. S.L..

Martínez-Ten P, Illescas Molina T, Soler Ruiz P, Adiego Burgos MB. Valoración ecográfica de la línea media del encéfalo fetal: estructuras y variantes de la normalidad. (2012). En: Martínez Cortés L y Huertas Fernández MA Editors. Neurosonografía fetal Normal (pp 13-30). Barcelona, España. Editorial Glosa. S.L..

Adiego MB. Curso Teórico Práctico de Ecografía SESEGO. Capítulo 15: Anatomía ecográfíca normal y Malformaciones de la Cara y Cuello fetales: pag 70-74. Ed SESEGO © 2012. ISBN: 978-84-615-3002-1

Adiego MB. Ecografía en el Primer Trimestre de la Gestación. Capítulo 1: Metodología de la exploración normal en el primer trimestre de la Gestación. Pag 9-17. Ed Enfoque Editorial SC.2012. ISBN:978-84-940632-0-6.

Adiego MB. Recomendaciones para la Organización de un Servicio de Obstetricia y Ginecología. Documentos de la Sociedad Española de Ginecologia y ObstetriciaCapítulo 2. Cribado de cromosomopatías en el primer trimestre de la gestación. pag117-145 ISBN: 978-84-608-9913-6 Depósito Legal: M-43248-2016


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